**5. Conclusion**

A multitude of approaches of local anesthetic blockade throughout the structure of brachial plexus and its branches are currently practiced to provide regional anesthesia and analgesia of distal upper extremity. The use of ultrasonography has not only revolutionized the conventional regional anesthesia techniques but also improved the access to the peripheral nerves at distal levels in the course of these neural structures. The major brachial plexus approaches like supraclavicular, infraclavicular, and axillary blocks have been shown to have equal success rates. Hence, the choice of the technique may be decided based on the experience of the practitioner, extent of the surgery, tourniquet use in the arm or forearm, and consideration of avoiding risks like pneumothorax, phrenic block, etc. For distal surgeries of short surgical duration, the IVRA and digital infiltration techniques can also be attractive options. Eliminating the tourniquet along with awake infiltration techniques can help fast track certain minor soft tissue procedures in nonoperating room settings.
